Empiric Antibiotic Use With Rescue Infliximab Does Not Improve Outcomes in Acute Severe Ulcerative Colitis: A...

Area of Science:

• Gastroenterology
• Clinical Pharmacology
• Health Services Research

Background:

• Acute severe ulcerative colitis (ASUC) management sometimes includes antibiotics to treat presumed infections.
• The clinical benefit of concurrent antibiotic use with infliximab in ASUC is not well-established.
• This study investigates the efficacy and outcomes of this common clinical practice.

Purpose of the Study:

• To evaluate the impact of concurrent antibiotic administration with infliximab rescue therapy in hospitalized ASUC patients.
• To determine if antibiotic use improves outcomes such as surgery, colectomy, sepsis, or mortality.
• To assess the association between concurrent antibiotic use and healthcare utilization.

Main Methods:

• Retrospective cohort study utilizing the TriNetX US Collaborative Network.
• Comparison of hospitalized ASUC patients receiving infliximab with and without concurrent antibiotics.
• Propensity score matching to balance baseline characteristics, followed by Kaplan-Meier analyses and hazard ratio calculations.

Main Results:

• Concurrent antibiotics with infliximab did not improve outcomes for IBD-related surgery, colectomy, sepsis, or mortality.
• Hazard ratios for surgery, colectomy, sepsis, and mortality were not significantly improved with antibiotic use.
• The antibiotic cohort showed increased utilization of emergency department and critical care services.

Conclusions:

• Empiric antibiotic administration with infliximab rescue therapy in ASUC does not enhance patient outcomes.
• Concurrent antibiotic use in ASUC may be linked to increased healthcare resource utilization.
• Clinical guidelines should reconsider the routine use of antibiotics in this setting.